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General NPI Number Information
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NPI Number | 1285074732
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Entity Type | Individual
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Provider Name | REBECCA DANIELLE RUSSELL
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Gender | Female
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Dates
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Enumeration Date | 06/28/2013
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 2615 N PRICKETT RD STE 10
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City | BRYANT
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State | AR
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Zip | 72022-7546
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Country | US
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Telephone | 501-847-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 7 ROLLING BROOK DR
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City | GREENBRIER
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State | AR
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Zip | 72058-9165
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Country | US
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Telephone | 870-822-9365
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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